Barriers and opportunities for refugee mental health services: clinician recommendations from Jordan

Abstract

Background Jordan has received more than three million refugees from bordering countries during times of conflict, including over 600 000 Syrian refugees between 2011 and 2021. Amidst this humanitarian crisis, a new mental health system for Syrian refugees has developed in Jordan, with most clinical services administered through non-governmental organizations. Prior studies have identified increased risk of psychiatric disorders in refugee populations and significant barriers for Syrian refugees seeking mental health treatment, but few have reviewed the organization or ability of local systems to meet the needs of this refugee population. Methods Qualitative interviews of mental health professionals working with refugees in Jordan were conducted and thematically analyzed to assess efficacy and organizational dynamics. Results Interviewees described barriers to care inherent in many refugee settings, including financial limitations, shortages of mental health professionals, disparate geographic accessibility, stigma, and limited or absent screening protocols. Additional barriers not previously described in Jordan were identified, including clinician burnout, organizational metrics restricting services, insufficient visibility of services, and security restrictions. Advantages of the Jordanian system were also identified, including a receptive sociopolitical response fostering coordination and collaboration, open-door policies for accessing care, the presence of community and grassroots approaches, and improvements to health care infrastructure benefiting the local populace. Conclusions These findings highlight opportunities and pitfalls for program development in Jordan and other middle- and low-income countries. Leveraging clinician input can promote health system efficacy and improve mental health outcomes for refugee patients.

Scaling the Children Immunization App (CIMA) to Support Child Refugees and Parents in the Time of the COVID-19 Pandemic: A Social Capital Approach to Scale a Smartphone Application in Zaatari Camp, Jordan

“…Also, previous studies documented increased risk of mental health problems among camp refugees and significant barriers for Syrian refugees seeking mental health treatment; this demonstrated that the Syrian camp refugee in Jordan continues to face significant stressors including symptoms of distress and reduced functioning in people’s daily activities due to their experience of emotional distress [ 9 ]. Shortage of mental health professionals, medication shortages, poor awareness of available mental health services, limited or absent screening protocols, and the financial hardship of refugee patients are significant limiting factors to accessing mental healthcare [ 29 ]. Therefore, the integration of the UNODC’s parenting skills material is timely and useful [ 13 , 27 ].…”

Understanding experiences of mental health help-seeking in Arab populations around the world: A systematic review and narrative synthesis.

“…Ten studies revealed trust as an important barrier. Immigrant and refugee populations in two studies expressed distrust in western mental health care systems (62, 94), and this was supported by one study with mental health professionals working with refugees (51). Issues surrounding mistrust and lack of con dence in competency and transparency of professionals were revealed, mostly in refugee and immigrant samples.…”

“…Language and communication barriers were reported in ten studies, primarily by refugee populations and Arabs in non-Arabic speaking countries. Service providers working with a refugee population in one study mutually reported language as a barrier (51). Individuals reported di culties in approaching professionals due to language barriers nding it challenging to express themselves.…”

The unmet surgical needs of global refugee populations: A perspective review

“… 37 However, refugee camps continue to face the issue of a severe shortage of healthcare workers ( Figure 3 ). 12 A 2016 study conducted by the Johns Hopkins Bloomberg School of Public Health estimated that 59.5 million displaced individuals globally required 2.78 million surgical procedures. 20 However, a sizable portion of these urgent surgical needs have not been met as a result of several issues, including a surgeon shortage.…”

“…This approach involves increasing funding for healthcare programmes, improving training and retention of healthcare workers and fostering coordination between humanitarian organisations and local healthcare systems. 11 , 12 By addressing these challenges, it becomes possible to alleviate the burden of surgical diseases and improve the overall health outcomes of the global refugee population. Thus, this review aims to explore the impact of various factors on the burden of surgical diseases among refugees and identify potential strategies for improvement.…”